Provider Demographics
NPI:1285971309
Name:JOHNSON, ERICA LYNNETTE
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LYNNETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5979 WESTGATE DR
Mailing Address - Street 2:APT. 1022
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5004
Mailing Address - Country:US
Mailing Address - Phone:407-283-2953
Mailing Address - Fax:
Practice Address - Street 1:5979 WESTGATE DR
Practice Address - Street 2:APT. 1022
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5004
Practice Address - Country:US
Practice Address - Phone:407-283-2953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH9940101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health